Case Management for Children and Pregnant Women07D0901F-86B6-4CD0-B7A2... · 2016-10-14 · Case Management for Children and Pregnant Women [graphic image] [DSHS and THSteps logos]

Case Management Services in Texas

Case Management for Children and

Pregnant Women

[graphic image]

[DSHS and THSteps logos]

DRAFT 12/10/09

Jan 2014


What is Case Management for

Children and Pregnant Women?


• Assist eligible clients in gaining access to

medically necessary medical, social,

educational and other services.

• Provides health related case management

services to Medicaid eligible children and

pregnant women.

• A Medicaid benefit and a component of the

Texas Health Steps services

Services


Comprehensive services are available for Medicaid-eligible:

Children birth through age 20 with health condition or health risk

Pregnant women of any age who have a high-risk condition

Eligibility


Need assistance in gaining access to

medically necessary medical, social,

educational, and other services related to the

health condition, health risk or high-risk

condition.

Wants case management.

*Must have needs related to health condition or

health risk; needs cannot be anticipatory.

Eligibility


• Nonprofit agencies/organizations

• Individual Owners

• Health-care clinics

• Schools & school districts

• Rehabilitation centers

Where do they work?

Who are Case Management

Providers? •Registered Nurse

•Licensed Social Worker


Identify needs of client and

their family

Develop plan to address

needs

Follow up with client and

family to ensure needs have

been addressed or resolved

How Does Case Management Help

Families?


How Do Case Managers Help?

Assist with

Accessing,

Advocating for,

and Coordinating

Needed Services

• Refer to developmental and mental health

services

• Advocate for school services/attend ARD

• Find resources to address psychosocial

issues- family violence, homelessness,

language barriers

• Assist with Medical Transportation referral

• Help obtain DME and supplies


Cont’d: How Do Case Managers Help? Identify

Strengths &

Challenges

Empower

Clients to Find

and Access

Services They

Need

• Encourage family to identify their own

strengths

• Identify barriers to accessing client

needs

• Encourage clients and families to

become active participants in their

health care and in seeking solutions to

their psychosocial, financial, or

educational concerns


How does it differ from other CM programs/Care Coordination?

• Home Visits are conducted.

• Visits are Face-to-Face.

• Case Manager may attend school meetings

with parent to advocate for client.

• The whole family is assessed, not just the

client.

• Services are provided only if client currently

has needs related to their health condition or

health risk.


•Does the client have a need that is related to their

condition?

•Is the need beyond the scope of other care coordination

that they may be receiving?

•Does a case manager need to go to the client’s home to

provide more intensive case management?

•Does a case manager need to help the parent with

school issues?

•Are there severe medical or behavioral issues that

warrant intervention from several professionals?

Referral Questions


Coordinating with ECI


Joseph, Age 2

Diagnosed with Autism, hearing impaired


Joseph

• Not receiving ECI or therapy

• Recommended for hearing aid but never got

one.

• Doesn’t know about waivers or SSI.

• Parents speak Farsi as their primary language


Roles

Case Management

•Refer to ECI

•Assist with accessing

hearing aids

•Research resources for

ABA

•Assist parent with

completing SSI application

•Assist with placing on

waiver interest lists

ECI

•Provide therapies

•Transition to PPCD or

private therapies

•Refer back to Case

Management if parents

want/need further case

management at age 3

(example--to attend ARD)


Carly, 5

Diagnosed with Cerebral Palsy


Role of Case Manager

• Assist with coordinating diapers, new

wheelchair and ramp

• Attend ARD per mother’s request

• Refer to waivers

• Assist with barriers encountered with Medical

Transportation.


Working with Health Care Plans

Scenarios for Mary and Jon


Mary

Case Management Scenario:

High-Risk Pregnancy

Concerns:

• No Prenatal Care/in 2nd

Trimester

• Homeless

• Depressed


Mary


High-Risk Pregnancy

Our Case Manager:

Referrals to housing, counseling and

WIC

Health Plan Case Manager:

Follow up to ensure OB care has

begun; placed in high risk group


Jon


Mental Health Condition

Concerns:

• Bipolar Disorder

• Now living with Grandma

• Stopped meds

• Suspended from school


Jon


Mental Health Condition

Our Case Manager:

•Referral to mental health

services

•Attend school meeting with

grandparent to advocate for

additional services.

Health Plan Case Manager:

•Assist to ensure medications

are obtained


Who can make a referral?

• Texas Health Steps Outreach/Informing

• Health Plans

• Health Care Professionals

• Community Agencies

• Schools

• Mental Health Professionals

• Anyone

Case Management Services in Texas April 19, 2012 THSteps Case Managers 24

Potential Referrals from Texas Health Steps Outreach/Informing

• Target At-Risk Outreach Lists Pregnant and Parenting Teens, DFPS,

SSI, Foster Care

• Referrals from health care providers and

other sources

• Referrals generated from new enrollment


How to Make a Referral?

• Fax referral form

• Call Texas Health Steps 1-877-847-8377

• Health Plans can send email to Texas

Health Steps-

[email protected]





Referral Form – on website


Actions following the referral:

• SSU attempts to contact client or parent.

• SSU provides Case Management Informing:

o Educate

o Encourage

o Empower

o Assist


Actions following the referral

(Cont.):

• If contacted and desire services, SSU

assists with scheduling appointment.

• Or SSU sends them list of case

management providers.

• If no contact, SSU mails letter to client.


For More Information

Documents

Case Management for Children and Pregnant Women07D0901F-86B6-4CD0-B7A2... · 2016-10-14 · Case Management for Children and Pregnant Women [graphic image] [DSHS and THSteps logos]